Predictors of early recurrence prior to planned post-operative radiation therapy for oral cavity squamous cell carcinoma and outcomes following salvage intensified radiation therapy
Menée à partir de données portant sur 601 patients atteints d'un carcinome épidermoïde de la cavité buccale traité par chirurgie puis radiothérapie entre 2003 et 2015, cette étude identifie les facteurs prédictifs associés à une récidice précoce puis évalue, du point de vue du taux d'absence de récidive à 3 ans, l'intérêt d'une radiothérapie de sauvetage
Purpose : To determine predictors and outcomes for oral squamous cell carcinoma (OSCC) patients who had early recurrence before commencement of postoperative radiotherapy (PORT).
Methods : Retrospective review was performed for OSCC patients treated with PORT between 2003-2015 following curative-intent surgery. Early recurrence was defined as tumor recurrence following surgical resection and before initiating planned PORT. Patients were classified into: 1) adjuvant-PORT group (no early recurrence), 2) salvage-PORT group (had locoregional early recurrence), and palliative-PORT group (had locoregional and distant early recurrence). For the whole cohort, multivariable analysis (MVA) was applied to identify predictors of early recurrence. In the salvage-group, the post-PORT recurrence-free rate was estimated, and MVA was used to identify predictors of recurrence-free rate, disease free- (DFS) and overall- survival (OS).
Results : A total of 601 patients were identified, of whom 513 (85%) were treated with adjuvant-PORT, while 88 (15%) had early recurrence (28/88, 32% were biopsy-proven) before PORT (70 in salvage-group and 18 in palliative-group). On MVA, oral tongue subsite, microscopic positive resection margin, pT3-4, and pN2-3 were associated with development of early recurrence (p<0.05 for all). The 3-year OS for OSCC patients treated with adjuvant and salvage PORT were 71% (95%CI:67%-75%) and 41% (95%CI:30%-56%) respectively (p<0.001) [median follow-up was 3.4 and 2.9 years respectively]. Following salvage-PORT, the 3-year recurrence-free rate was 36% (95%CI:23%-47%). On MVA, extranodal extension and volume of early recurrent gross disease were associated with poor recurrence-free rate, DFS and OS (p<0.05 for all).
Conclusion : Early recurrences are not uncommon in patients with high risk features.. Future studies are required to improve prediction and outcomes of this very high risk group.
International Journal of Radiation Oncology • Biology • Physics , résumé, 2017